Real-Time Systemic Hemodynamic Monitoring in Children with Congenital Heart Disease: Comparison of Two Anesthetic Induction Protocols
Ding Han1, Ya-Guang Liu2, Yi Luo1, Jia Li MD3, Chuan Ou-Yang1,2*
- *Corresponding Author:
- Chuan Ou-Yang
Anesthesia Department, Capital Institute of Pediatrics Affiliated Children’s Hospital
2 Yabao Street, Chaoyang District, Beijing, China
E-mail: [email protected]
Received date: May 29, 2017; Accepted date: June 12, 2017; Published date: June 15, 2017
Citation: Han D, Liu YG, Luo Y, Jia Li MD, Ou-Yang C (2017) Real-Time Systemic Hemodynamic Monitoring in Children with Congenital Heart Disease: Comparison of Two Anesthetic Induction Protocols. J Anesth Clin Res 8:731. doi: 10.4172/2155-6148.1000731
Copyright: © 2017 Han D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objective: Inhaled sevoflurane and intravascular ketamine are commonly used for congenital heart defect (CHD) children undergoing cardiac surgery. We used a new and direct systemic hemodynamic monitoring technique pressure recording analytical method (PRAM) to compare the effects of sevoflurane-midazolam-sufentanil and ketamine-midazolam-sufentanil during anesthesia induction.
Methods: Forty-three children with ventricular septal defect (2.2 ± 1.2 years) were randomized to receive sevoflurane (Group S) or ketamine (Group K) for basal anesthesia, followed by combined intravenous anesthetics and intubation. Hemodynamic data recorded by PRAM included heart rate (HR), systolic (SBP), diastolic (DBP) and mean (MBP) blood pressure, stroke volume index (SVI), cardiac index (CI), systemic vascular resistance index (SVRI), the maximal slope of systolic upstroke (dp/dtmax) after basal anesthesia, 1, 2, 5 min after combined intravenous anesthetics, 1, 2, 5 and 10 min after tracheal intubation. Rate-pressure product (RPP) and cardiac power output (CPO) were calculated.
Results: HR, SBP, DBP and MBP showed a significant decrease during induction (p<0.001 for all), then a small and significant increase at intubation (p<0.0001 for all), followed by a gradual decrease (p<0.0001 for all). As compared to group S, group K had faster decreases during induction in arterial pressures (p<0.01 for all), higher HR, arterial pressures, SVRI, dp/dtmax, RPP, lower SVI, CI, CPO (p<0.05 for all) during the study period.
Conclusion: Sevoflurane, as compared to ketamine, resulted in stable and favorable effects on systemic hemodynamics and myocardial energetic in children with ventricular septal defect.